This is a competitive renewal of an R15 AREA study that examined emerging trends in methamphetamine (MA) use among a sample of 65 male and 35 female MA users in the suburbs. We found that the suburban setting increases risk factors for female drug users, including risk behaviors associated with transmission of human immunodeficiency virus (HIV), hepatitis C virus (HCV) and sexually transmitted infections (STIs). In expanding upon our original study, we will continue to explore emerging trends in MA use in the suburbs, focusing exclusively on female MA users, an understudied and neglected population of drug users. Additionally, women living in the suburbs face barriers to drug treatment and healthcare due to restricted access to health services, lack of drug-related risk awareness, and the gendered stigmatization of suburban MA use that intensifies the hidden status of this population. The broad goal of this renewal study is to gain a more in-depth understanding of gendered drug-use trajectories and risk behavior patterns.
Our specific aims i n this competitive renewal study are (1) to expand our exploration into the turning points in drug use trajectories among suburban women who use MA;(2) to provide a more comprehensive understanding of the risks and protective factors that impact the transmission of HIV, HCV and STIs specific to female MA users living in the suburbs;and (3) to assess HIV risk awareness, risk behaviors, healthcare utilization and accessibility to healthcare services over time for a sub-sample of suburban female MA users. The sample in this renewal study will include 30 suburban female MA users (15 former and 15 current users). As a novel line of investigation, we will use a longitudinal design to collect data at three points: 30 new in-depth interviews, followed 3-6 months later by 30 follow-up interviews, and followed another 3-6 months later by focus groups with the same sample population. Participants are provided risk-reduction and healthcare literature at each interview. Follow-up interviews focus on changes in specific drug use patterns, social context of drug use, HIV- risk behaviors, healthcare utilization, and access to health services and treatment, which are new areas of this renewal study. Data analysis will be informed by life course and symbolic interaction theories. First, the findings will provide a more comprehensive understanding of the gender differences found in our original study on MA use in suburban Atlanta. Second, the longitudinal design will identify HIV-risk behaviors among suburban female MA users and changes in risk behaviors over time. Third, knowledge regarding the utilization of health services and access to needed healthcare among this study population will better inform future healthcare initiatives. Additionally, findings will yield recommendations for gender-specific and socially appropriate interventions at the individual and community levels for suburban female MA users.

Public Health Relevance

Epidemiological data show a steady increase in methamphetamine (MA) use and HIV-risk behaviors associated with MA use, and suburban women who use MA are an understudied and neglected population of drug users. This renewal study is an exploration of HIV-risk awareness, HIV-risk behaviors, healthcare utilization, and access to health services and treatment for suburban female MA users. The findings will yield recommendations for gender-specific and socially appropriate interventions at the individual and community levels.